Glioblastoma (GBM): Understanding Your Treatment Options

Glioblastoma (GBM) is the most aggressive primary brain tumour. This guide explains what it is, how it is treated, and what to expect — honestly and clearly.

What Is GBM?

GBM is a WHO Grade IV brain tumour that grows within brain tissue itself. Tumour cells infiltrate surrounding brain along microscopic paths — which is why surgery alone cannot cure it.

It mainly affects adults in their 60s–70s, accounting for roughly 15% of primary brain tumours.

Symptoms

• New seizures, progressive weakness, or speech difficulty
• Morning headaches with nausea
• Personality or cognitive changes

Symptoms developing over weeks — not years — are more concerning.

Diagnosis

MRI with contrast shows a ring-enhancing mass with central necrosis. Surgery or biopsy provides tissue for diagnosis and molecular testing.

Key molecular markers:

• IDH status — IDH-wildtype GBM is the most aggressive form
• MGMT methylation — present in ~40% of GBMs; predicts better response to chemotherapy

The Stupp Protocol (Standard Treatment)

1. Surgery — maximal safe resection using intraoperative MRI, 5-ALA fluorescence, and neuromonitoring. Awake craniotomy for tumours near speech or motor areas.
2. Concurrent radiotherapy + temozolomide — 6 weeks of daily radiation with chemotherapy.
3. Adjuvant temozolomide — 6 months of chemotherapy cycles.

Additional Options

• Bevacizumab — reduces tumour swelling; used in recurrent GBM
• TTFields (Optune) — wearable device that disrupts cell division; improves survival when added to treatment
• Clinical trials — discussed with all eligible patients

Prognosis

Median survival with treatment is 14–16 months. MGMT methylation, age, and extent of resection all influence individual outcomes. Population statistics do not define what is possible for an individual.

Care Philosophy

Treatment aims to extend life and protect its quality. Palliative care is involved early as a partner — not a last resort.

Frequently asked questions

What is glioblastoma (GBM)? Glioblastoma is a WHO Grade IV brain tumour, the most aggressive type of primary brain tumour. It grows within the brain tissue itself and infiltrates surrounding brain along microscopic paths, which is why surgery alone cannot cure it. It mainly affects adults in their 60s to 70s and accounts for roughly 15% of primary brain tumours.

What are the symptoms of glioblastoma? Common symptoms include new seizures, progressive weakness or speech difficulty, morning headaches with nausea, and personality or cognitive changes often noticed first by family members. Symptoms that develop over weeks rather than years are more concerning for a tumour.

Can glioblastoma be cured by surgery alone? No. GBM cells infiltrate the surrounding brain along microscopic paths that cannot be seen or removed even with maximal safe resection, so surgery is combined with radiotherapy and chemotherapy (the Stupp Protocol) rather than used as a standalone cure.

What is the Stupp Protocol for glioblastoma? The Stupp Protocol is the standard treatment sequence for GBM: maximal safe surgical resection (using intraoperative MRI, 5-ALA fluorescence, and neuromonitoring), followed by 6 weeks of concurrent radiotherapy and temozolomide chemotherapy, then 6 months of adjuvant temozolomide cycles.

What is the survival outlook for glioblastoma? Median survival with treatment is 14 to 16 months, though this varies by individual based on MGMT methylation status, age, and extent of surgical resection. Population statistics describe averages, not what is possible for a specific individual — this is discussed openly with every patient.

Contact KPJ Tawakkal to arrange a consultation. Timing matters.